Payment Year

Birth Date (MM/DD/YYYY) or AgeGender

Demographic Risk Factors

InstitutionalMedicaid
Current Medicare Eligibility due to
Original Medicare Eligibility due to Disability


Model
HCC
Description
Override
Score
DX1     
DX2     
DX3     
DX4     
DX5     
DX6     
DX7     
DX8     
DX9     
DX10